An eight-quarter review of FFS SNF discharge patterns, destination concentration, and FSHR performance across an 18-hospital health system spanning South Carolina — from the flagship academic medical center in Charleston to community hospitals in the Pee Dee, Lowcountry, Midlands, and Grand Strand regions.
MUSC Health operates South Carolina’s only academic medical center health system, now spanning 18 hospitals from Charleston to the Midlands, Pee Dee, and Grand Strand. Its post-acute discharge picture is one of meaningful scale — 1,496 Medicare fee-for-service patients flowing across 142 SNF destinations over eight quarters — with limited cross-hospital coordination and no unified preferred-network infrastructure to manage FSHR performance systematically.
Over eight quarters (2024 Q1 – 2025 Q4 (FFS); 2023 (CMS Payer Mix)), MUSC Health hospitals collectively discharged 1,496 fee-for-service Medicare patients to skilled nursing facilities, reaching 142 distinct SNF destinations across South Carolina. MUSC Health University Medical Center (Charleston Campus) leads the system in post-acute volume with 465 patients across 79 SNF destinations — the single largest MUSC Health post-acute relationship set in the analysis. MUSC Health Florence Medical Center is the second-highest volume hospital in the system, contributing 236 FFS SNF patients.
South Carolina state SNF utilization average is 13.4% (FFS). What the data reveals is a system-wide FSHR elevation and destination fragmentation story: across 11 active hospitals, 1,496 patients are distributed to 142 SNFs, most operating without a structured performance framework or preferred-network accountability from MUSC care teams.
Within MUSC’s existing discharge patterns is a structural starting point for coordination: 78 SNFs already serve two or more MUSC Health hospitals simultaneously. These shared facilities are the organic preferred network — facilities that MUSC hospitals have collectively chosen through discharge patterns without any formal coordination. Puzzle Healthcare’s role is to formalize that organic network, extend its reach, and make FSHR performance systematically measurable and accountable.
The 15 priority SNF targets identified in this analysis — facilities with elevated FSHR rates appearing across multiple MUSC Health hospitals — represent the highest-impact starting cohort for an embedded clinical program. Together they account for significant patient volume and carry FSHR rates meaningfully above the system-wide average of 42.9%.
MUSC Health operates 18 acute-care hospitals across South Carolina — from the flagship academic medical center in Charleston to community hospitals in Lancaster, Chester, Marion, Florence, Kershaw, Orangeburg, Columbia, and the Grand Strand. Each hospital draws from a distinct patient population and sends patients to a partially overlapping, partially distinct set of SNF partners across the state.
MUSC Health’s geographic span across South Carolina represents both a strategic complexity and a significant opportunity. The system’s hospitals serve distinct regional communities — academic medicine in Charleston, trauma and tertiary care in Florence and Orangeburg, community access in Chester and Marion, rapidly growing suburban markets in Columbia and Lancaster, and the Grand Strand retirement corridor through the Tidelands partnership. This diversity means that post-acute discharge patterns, local SNF networks, and FSHR drivers differ meaningfully across facilities. A coordinated preferred-network framework delivers the greatest operational value precisely in this kind of heterogeneous multi-hospital system: unified performance standards, embedded clinical presence, and real-time visibility that operates consistently across all 11 hospitals regardless of geography.
MUSC Health University Medical Center (Charleston Campus)’s 79-facility SNF destination network illustrates a pattern common to high-volume academic medical centers: a small number of facilities receive outsized volume, while the majority consist of lower-volume relationships that are difficult to manage systematically. This concentration and fragmentation dynamic — replicated across 11 hospitals and 142 SNF destinations — is the core visibility challenge at the heart of MUSC Health’s post-acute situation.
The concentration pattern at MUSC Health University Medical Center (Charleston Campus) is characteristic of a large academic medical center in a geographically concentrated state. Its top SNF partners already have the volume to support an embedded clinical presence — and they clearly have established relationships with UMC Charleston’s discharge planning teams. The coordination gap lives in the long tail: the facilities receiving smaller patient volumes with no systematic performance framework or preferred-network accountability.
Multiplied across 11 MUSC hospitals and 142 total SNF destinations system-wide, that long tail represents hundreds of downstream facilities operating beyond the horizon of MUSC’s visibility. That is precisely the structural problem a unified preferred-network framework addresses — starting with the 78 cross-system facilities that already appear in multiple MUSC discharge networks simultaneously.
South Carolina state SNF utilization benchmark: 13.4% (FFS). SC 30-day readmission average: 15.0%. The system-wide FSHR of 42.9% serves as the primary internal reference point for identifying hospitals with elevated return-to-hospital rates and high-impact intervention opportunities.
MUSC Health University Medical Center (Charleston Campus) discharged 465 FFS patients to 79 distinct SNF destinations over the analysis period. FSHR stands at 43.7%, +0.9pp vs system average. The leading post-acute destination is Spring Street Health Center (69 patients, 11.7% share). The hospital’s SNF network includes 21 facilityies with a “Very High” risk category.
The UMC Charleston post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at UMC Charleston’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Spring Street Health Center | 69 | 11.7% | 34.5% | High |
| Nhc Healthcare, Charleston | 58 | 9.9% | 54.5% | High |
| Bishop Gadsden Episcopal Retirement Community | 47 | 8.0% | 22.0% | High |
| Johns Island Post Acute | 39 | 6.6% | 50.6% | High |
| Wellmore Of Daniel Island Llc | 38 | 6.5% | 30.3% | High |
MUSC Health Florence Medical Center discharged 236 FFS patients to 47 distinct SNF destinations over the analysis period. FSHR stands at 47.9%, +5.1pp vs system average. The leading post-acute destination is The Palms At Florence (79 patients, 23.8% share). The hospital’s SNF network includes 16 facilityies with a “Very High” risk category.
The Florence post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Florence’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| The Palms At Florence | 79 | 23.8% | 46.2% | High |
| Presbyterian Home Of Sc - Florence | 29 | 8.7% | 44.2% | High |
| Kingstree Nursing Facility | 25 | 7.5% | 47.5% | High |
| Lake City Healthcare Center | 24 | 7.2% | 48.9% | High |
| Southland Health Care Center | 21 | 6.3% | 62.3% | High |
Tidelands Waccamaw Community Hospital discharged 208 FFS patients to 20 distinct SNF destinations over the analysis period. FSHR stands at 36.8%, -6.1pp vs system average. The leading post-acute destination is Nhc Healthcare, Garden City (95 patients, 41.9% share). The hospital’s SNF network includes 4 facilityies with a “Very High” risk category.
The Waccamaw post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Waccamaw’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Nhc Healthcare, Garden City | 95 | 41.9% | 36.4% | High |
| Litchfield Retirement, Llc | 65 | 28.6% | 32.6% | High |
| Angel Oak Nursing And Rehabilitation Center Llc | 35 | 15.4% | 40.0% | High |
| Compass Post Acute Rehabilitation | 13 | 5.7% | 51.5% | High |
| Prince George Healthcare Center | <11 | — | — | High |
MUSC Health Orangeburg Medical Center discharged 124 FFS patients to 25 distinct SNF destinations over the analysis period. FSHR stands at 50.6%, +7.7pp vs system average. The leading post-acute destination is Jolley Acres Healthcare Center (42 patients, 25.9% share). The hospital’s SNF network includes 8 facilityies with a “Very High” risk category.
The Orangeburg post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Orangeburg’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Jolley Acres Healthcare Center | 42 | 25.9% | 49.1% | Elevated |
| The Oaks Healthcare Llc | 40 | 24.7% | 62.4% | High |
| Edisto Post Acute | 28 | 17.3% | 32.3% | High |
| Calhoun Convalescent Center | 14 | 8.6% | 57.9% | High |
| Anchor Post Acute | <11 | — | — | Elevated |
MUSC Health Columbia Medical Center Downtown discharged 114 FFS patients to 43 distinct SNF destinations over the analysis period. FSHR stands at 46.1%, +3.3pp vs system average. The leading post-acute destination is Nhc Healthcare, Parklane (30 patients, 14.8% share). The hospital’s SNF network includes 21 facilityies with a “Very High” risk category.
The Columbia Downtown post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Columbia Downtown’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Nhc Healthcare, Parklane | 30 | 14.8% | 37.9% | High |
| Wildewood Retirement Llc | 26 | 12.8% | 47.4% | High |
| Karesh Long Term Care | 22 | 10.8% | 39.5% | High |
| Pruitthealth - Blythewood | 19 | 9.4% | 63.0% | High |
| Rice Nursing Home | 17 | 8.4% | 48.5% | High |
MUSC Health Kershaw Medical Center discharged 112 FFS patients to 17 distinct SNF destinations over the analysis period. FSHR stands at 38.0%, -4.8pp vs system average. The leading post-acute destination is Karesh Long Term Care (86 patients, 55.1% share). The hospital’s SNF network includes 3 facilityies with a “Very High” risk category.
The Kershaw post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Kershaw’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Karesh Long Term Care | 86 | 55.1% | 38.5% | High |
| Springdale Healthcare Center | 26 | 16.7% | 36.4% | Elevated |
| Wildewood Retirement Llc | <11 | — | — | Elevated |
| Mccoy Memorial Nursing Center | <11 | — | — | Moderate |
| Life Care Center Of Columbia | <11 | — | — | High |
MUSC Health Lancaster Medical Center discharged 109 FFS patients to 15 distinct SNF destinations over the analysis period. FSHR stands at 40.1%, -2.7pp vs system average. The leading post-acute destination is Lancaster Convalescent Center (57 patients, 40.4% share). The hospital’s SNF network includes 9 facilityies with a “Very High” risk category.
The Lancaster post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Lancaster’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Lancaster Convalescent Center | 57 | 40.4% | 46.1% | High |
| White Oak Manor Lancaster | 52 | 36.9% | 33.6% | High |
| Bennettsville Health And Rehabilitation Center | <11 | — | — | Moderate |
| Karesh Long Term Care | <11 | — | — | High |
| Liberty Commons Nursing And Rehabilitation Center Of Matthews, Llc | <11 | — | — | High |
MUSC Health Columbia Medical Center Northeast discharged 49 FFS patients to 24 distinct SNF destinations over the analysis period. FSHR stands at not available in this data period. The leading post-acute destination is Rice Nursing Home (15 patients, 15.6% share). The hospital’s SNF network includes 8 facilityies with a “Very High” risk category.
The Columbia Northeast post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Columbia Northeast’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Rice Nursing Home | 15 | 15.6% | — | Elevated |
| Nhc Healthcare, Parklane | 12 | 12.5% | — | Elevated |
| Pruitthealth - Blythewood | 11 | 11.5% | — | High |
| Karesh Long Term Care | 11 | 11.5% | — | Elevated |
| Wildewood Retirement Llc | <11 | — | 35.5% | High |
Tidelands Georgetown Memorial Hospital discharged 48 FFS patients to 7 distinct SNF destinations over the analysis period. FSHR stands at 33.3%, -9.6pp vs system average. The leading post-acute destination is Prince George Healthcare Center (32 patients, 45.1% share). The hospital’s SNF network includes 3 facilityies with a “Very High” risk category.
The Georgetown post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Georgetown’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Prince George Healthcare Center | 32 | 45.1% | 33.3% | High |
| Oak Hollow Of Georgetown Rehabilitation Center, Llc | 16 | 22.5% | — | High |
| Tidelands Health Skilled Care | <11 | — | — | Moderate |
| Litchfield Retirement, Llc | <11 | — | — | Elevated |
| Nhc Healthcare, Garden City | <11 | — | — | High |
MUSC Health Chester Medical Center discharged 16 FFS patients to 10 distinct SNF destinations over the analysis period. FSHR stands at 25.0%, -17.9pp vs system average. The leading post-acute destination is Musc Health Chester Nursing Center (16 patients, 61.5% share). The hospital’s SNF network includes 4 facilityies with a “Very High” risk category.
The Chester post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Chester’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Musc Health Chester Nursing Center | 16 | 61.5% | 25.0% | High |
| Franke Health Care Center | <11 | — | — | Moderate |
| Heartland Health Care Center-Union | <11 | — | — | High |
| Lancaster Convalescent Center | <11 | — | — | High |
| Pruitthealth - Ridgeway | <11 | — | — | High |
MUSC Health Marion Medical Center discharged 15 FFS patients to 11 distinct SNF destinations over the analysis period. FSHR stands at 31.4%, -11.5pp vs system average. The leading post-acute destination is Musc Health Mullins Nursing Center (15 patients, 41.7% share). The hospital’s SNF network includes 1 facilityy with a “Very High” risk category.
The Marion post-acute network illustrates the broader MUSC pattern: a small number of high-volume SNF relationships account for the top discharge share, while the remaining volume is distributed across a long tail of facilities that operate without systematic performance oversight. A preferred-network framework anchored at Marion’s highest-volume destinations — with embedded clinical presence at the most critical facilities — would immediately extend coordinated care management across the majority of this hospital’s post-acute volume.
| Top SNF Partners | Pts | Share | FSHR | Risk |
|---|---|---|---|---|
| Musc Health Mullins Nursing Center | 15 | 41.7% | 31.4% | High |
| Bennettsville Health And Rehabilitation Center | <11 | — | — | Moderate |
| Bethea Baptist Healthcare | <11 | — | — | Moderate |
| Faith Healthcare Center | <11 | — | — | Moderate |
| Florence Rehab & Nursing Center | <11 | — | — | Moderate |
Of the 142 SNF destinations across the MUSC network, 78 already serve two or more MUSC hospitals simultaneously. These shared facilities are the structural backbone of any preferred-network strategy — existing relationships that can be elevated and formalized without requiring new partnerships to be built from scratch.
Karesh Long Term Care is among the most connected SNFs in the MUSC Health network — serving 6 hospitals with 119 total patients. The other high-volume cross-system facilities represent the tier of shared relationships where a coordinated embedded clinical presence delivers immediate and demonstrable impact across multiple MUSC hospitals simultaneously.
Of particular note are cross-system facilities with elevated FSHR: SNFs that already appear in multiple MUSC discharge patterns are precisely the facilities where an embedded clinical presence and preferred-network performance standards create the accountability needed to drive measurable FSHR improvement across the system’s post-acute continuum.
The 78 cross-system facilities represent the natural starting cohort for a coordinated MUSC preferred network. A structured engagement beginning with these shared partners would immediately extend coverage across the broadest reach of MUSC hospitals and create the governance layer for performance tracking across the most consequential downstream relationships in the system.
The priority target analysis identifies SNFs with elevated FSHR rates, meaningful patient volume, and cross-hospital presence across the MUSC system. These facilities represent the intersection of high clinical risk and strategic leverage: where an embedded Puzzle clinical presence would deliver immediate impact across multiple MUSC hospitals simultaneously.
The Oaks Healthcare Llc leads the priority target list with a priority score of 7.8 — an FSHR of 62.4% across 3 MUSC hospitals and 40 patients. The FSHR elevation at this facility — 19.6% above the system average — represents the type of high-volume, high-FSHR, multi-hospital relationship where an embedded Puzzle clinical presence delivers immediate and measurable return.
Together, the 15 priority targets cover relationships across the majority of MUSC’s active hospital portfolio. A coordinated engagement beginning with these facilities would immediately extend Puzzle’s embedded presence into the highest-risk corner of MUSC Health’s post-acute network — without requiring a facility-by-facility cold-call campaign. MUSC’s endorsement opens those doors, and Puzzle’s embedded clinical model provides the sustained presence to drive FSHR improvement over time.
Every active MUSC hospital is scored on a composite of discharge volume, destination breadth, FSHR elevation, and destination-level facility risk. The index surfaces relative priority — not a critique of any individual hospital’s care quality, but a guide to where systematic post-acute infrastructure delivers the greatest immediate return. SC state SNF utilization benchmark: 13.4% (FFS).
| Hospital | Beds | SNF Pts | Dests | FSHR % | Score | Priority |
|---|---|---|---|---|---|---|
| MUSC Health Florence Medical Center | 310 | 236 | 47 | 47.9% | 66 | Immediate |
| MUSC Health University Medical Center (Charleston Campus) | 709 | 465 | 79 | 43.7% | 63 | Immediate |
| MUSC Health Orangeburg Medical Center | 286 | 124 | 25 | 50.6% | 58 | Immediate |
| MUSC Health Chester Medical Center | 82 | 16 | 10 | 25.0% | 52 | Near-Term |
| MUSC Health Kershaw Medical Center | 119 | 112 | 17 | 38.0% | 47 | Near-Term |
| MUSC Health Lancaster Medical Center | 199 | 109 | 15 | 40.1% | 46 | Near-Term |
| MUSC Health Marion Medical Center | 124 | 15 | 11 | 31.4% | 46 | Near-Term |
| MUSC Health Columbia Medical Center Downtown | 258 | 114 | 43 | 46.1% | 40 | Near-Term |
| MUSC Health Columbia Medical Center Northeast | 74 | 49 | 24 | — | 36 | Near-Term |
| Tidelands Waccamaw Community Hospital | 119 | 208 | 20 | 36.8% | 35 | Near-Term |
| Tidelands Georgetown Memorial Hospital | 131 | 48 | 7 | 33.3% | 22 | Monitor |
MUSC Health Florence Medical Center leads the opportunity ranking with a score of 66 — driven primarily by its FSHR elevation and the breadth of its SNF destination network. A high-volume hospital with elevated FSHR and a large, largely unmanaged SNF network is precisely where a preferred-network infrastructure delivers maximum return on clinical investment.
MUSC Health University Medical Center (Charleston Campus) (63 score, Immediate) and other Near-Term hospitals represent the tier where FSHR elevation merits structured attention. Their geographic position across the MUSC system means that a preferred-network framework anchored at the top hospitals naturally extends coverage to the Near-Term tier.
Puzzle Healthcare’s engagement model is built around one core insight: the most effective way to improve post-acute outcomes at a health system is to establish an embedded presence inside the SNF network itself. That requires the health system’s endorsement to open the door. When OSF HealthCare did exactly that, it changed the economics of the entire engagement.
The OSF Precedent: When OSF HealthCare partnered with Puzzle Healthcare, the system introduced Puzzle to approximately 60 nursing homes across their post-acute network. That single act of introduction — OSF telling its downstream SNF partners that Puzzle had the health system’s trust and support — opened relationships that would have taken years to build through conventional vendor outreach. The embedded clinical presence that followed enabled real-time visibility, coordinated care management, and measurable FSHR improvement across all 60 facilities simultaneously.
MUSC Health has 142 unique SNF destinations — a network of meaningful scale across South Carolina. MUSC’s 78 cross-system shared facilities represent the natural introductions cohort: SNFs that already know and trust multiple MUSC hospitals, and where a coordinated Puzzle presence would have an immediate and demonstrable impact on FSHR performance. That is 78 introductions — many times the minimum needed to make the engagement economics work — before Puzzle has made a single cold call.
The engagement economics of Puzzle’s model require a minimum scale to be operationally viable: an embedded presence in a facility that receives only 8–10 patients per year cannot be sustained. MUSC’s cross-system SNF concentration solves this elegantly. The top cross-system facilities collectively receive enough volume across multiple MUSC hospitals to support a full embedded clinical program from day one — and their FSHR elevation makes the case for urgency clear.
The explicit ask mirrors the OSF model: MUSC introduces Puzzle to its downstream SNF partners — particularly the 78 cross-system facilities where the relationship already exists — so that Puzzle can establish a coordinated presence across the network. With OSF, 60 such introductions built the foundation for a system-wide preferred network. MUSC’s 78 cross-system facilities represent a comparable starting point, with a clear path to expanding across the full 142-destination network as the preferred-network framework matures.
The following sequence is designed to move efficiently from this initial analysis to a working preferred-network engagement, with no disruption to existing care pathways during the design phase.
MUSC Health has built South Carolina’s most expansive academic health system, spanning 18 hospitals from the flagship academic medical center in Charleston to community hospitals in every major region of the state. 1,496 FFS patients, 142 SNF destinations, 11 active hospitals, and 78 facilities already embedded in multiple MUSC care pathways simultaneously. That is not a system with a post-acute crisis. It is a system with a post-acute opportunity that has not yet been systematically activated.
MUSC’s 11-hospital post-acute network currently operates as 11 largely independent discharge patterns, each sending patients to their own set of SNF destinations without shared FSHR standards, systematic accountability, or a unified visibility layer connecting MUSC care teams to downstream SNF performance. The 15 priority SNF targets — facilities with FSHR rates significantly above the system average of 42.9% appearing across multiple MUSC hospitals — represent the highest-urgency intervention points. But they are part of a larger structural story: 142 SNF destinations, most operating beyond the horizon of MUSC’s systematic oversight.
The 78 cross-system SNFs — facilities that already serve multiple MUSC hospitals and have demonstrated their relevance to the system’s post-acute continuum — are the proof of concept. These are not hypothetical preferred partners; they are already functioning as the de facto preferred network across South Carolina. Puzzle’s role is to formalize it, extend it, and make FSHR performance systematically measurable and accountable.
The explicit ask: Introduce Puzzle to MUSC’s downstream SNF partners — beginning with the 78 cross-system facilities and 15 priority targets that already serve multiple hospitals — so that Puzzle can establish a coordinated embedded presence across the network. When OSF HealthCare made that introduction across approximately 60 nursing homes, the result was a system-wide preferred-network program built on existing trust. MUSC has the same structural foundation — at a scale that makes the opportunity commensurately significant for South Carolina’s leading health system.
We look forward to the conversation — and to what MUSC Health’s post-acute program looks like with the visibility, FSHR accountability, and coordination infrastructure to match the system’s clinical ambition across South Carolina.